Symptoms of ADHD

The recent Diagnostic and Statistical Manual of Mental Disorders
of the American Psychiatric Association, Fifth Edition (DSM5), published in May
2013 represents the first major revision to the diagnostic manual since 1994
and describes the key ADHD symptoms in detail

To qualify for a diagnosis of ADHD, the above symptoms should,
according to the DSM5, present in childhood, and cause difficulty in achieving
healthy social, academic or occupational outcomes (as well as frequently
affecting behaviour.)

There are nice possible hyperactive and impulsive ADHD
symptoms:

often fidgets with or taps hands or squirms in seat

often leaves seat in situations when remaining seated is
expected (eg leaves his or her place in the classroom, in the office or other
workplace or in other situations that require remaining in place)

often runs about or climbs in situations where it is
inappropriate (eg in adolescents or adults, may be limited to feeling
restless)

often unable to play or engage in leisure activities
quietly

is often 'on the go' acting as if 'driven by a motor' (eg is
unable to be or uncomfortable being still for an extended time, as in
restaurants, meetings; may be experienced by othersas being restless or
difficult to keep up with

often talks excessively

often blurts out answers before questions have been completed
(eg completes people’s sentences; cannot wait for turn in
conversation)

often has difficulty awaiting turn (eg while waiting in
line)

often interrruptsor intrudes on others (e.g butts into
conversations, games, or activities; may start using other people's things
without asking or receiving permission ; for adolescents and adults may intrude
into or take over what others are doing).

There are nine possible inattentive ADHD symptoms:

often fails to give close attention to details or makes
careless mistakes in schoolwork, work, or during other activities (eg overlooks
or misses details, work is inaccurate)

often has difficulty sustaining attention in tasks and play
activities (eg has difficulty remaining focussed during lectures, conversations
or lengthy reading)

often doesnot listen when spoken to directly (eg mind seems to
be elsewhere, even in the absence of obvious distraction)

often does not follow through on instructions and fails to
finish school work, chores, or duties in the work place (eg starts tasks but
quickly loses focus and is easily sidetracked)

To possibly warrant a diagnosis of ADHD individuals younger than
17 years of age should display at least six out of nine inattentive and/or
hyperactive-impulsive symptoms. For individuals aged 17 years and above only
five out of nine or more are required.

Other criteria to be met:

'several inattentive or hyperactive-impulsive symptoms were
present before age 12 years'

'several inattentive or hyperactive-impulsive symptoms are
present in two or more settings'

'clear evidence that the symptoms interfere with, or reduce the
quality, of social, academic, or occupational functioning

the symptoms do not occur exclusively during the course of
schizophrenia or other psychotic disorder and are not better accounted for by
another mental disorder'.

ADHD symptom clusters are now categorised as:

'combined' (sometimes described as 'severe', with a combination
of hyperactivity, impulsivity and inattention)

'predominantly hyperactive-impulsive'

'predominantly inattentive'.

These are described as different ADHD 'presentations',
reflecting the fluidity and change in how ADHD may present in the same
individual over time.

Specialists are also expected to specify the ADHD severity based
on their clinical judgement of the degree of impairment observed (ie 'mild,
moderate or severe').

Effect of ADHD on social relationships and self-esteem

Your child might:

go on and on about a subject and can take over a
conversation

'act silly' in a group to get attention but not fit
in

damage other children's toys etc, without meaning to

play too roughly in the playground and hurt other children

have poor motor skills (eg can't catch or throw a ball).

Other children may feel your child is being bossy, silly,
clumsy, too rough or will make their team lose. So, they may avoid your child
in the playground and won't invite her to parties.

Your child may be the last one chosen for a team. This can make
your child feel rejected and develop low
self-esteem.

Impulsive and poorly regulated behaviours will make children
with ADHD unpopular, leading to feelings of rejection and reduced self-esteem.

It's also likely that other children will egg them on to bad
behaviour or tease, knowing they are easily wound up and will overreact.

He/she will forget the rules of a game, won't answer or makes
silly mistakes – so other children won't choose them to be on their team or
will tease in the playground. Your child may believe they arestupid and
self-esteem will drop. They will need a lot of support and reassurance.

Your child will need monitoring to make sure they aren't
aggressive with other
children. They may be tempted more than others to try alcohol, drugs or
abuse substances because they do not think about the consequences until it's
too late.

The effect of ADHD on parents

Keeping up with your child to make sure they're safe can be
exhausting! You may worry that you've done something wrong because your child
doesn't behave as well as their peers.

It can place a strain on friendships with other parents,
particularly if their children are hurt or things are damaged by your child.

Your child will say things that may hurt or embarrass you or
others, putting a strain on relationships. Inability to wait will mean they
will interrupt you constantly, which can be wearing.

When your child loses things, doesn't answer or do what you ask
her to do, it can be exasperating. You may end up shouting and then feeling
guilty because your child didn't do it deliberately.

The effect of ADHD on educational progression

Your child can miss things because they are fidgeting and
doesn't hear what's being said. They may fall behind without extra help to
cover the ground missed.

Symptoms of inattention may also affect short-term memory and
making it difficult for your child to do two things at once, so handwriting and
presentation may be poor.

Your child may therefore have problems structuring schoolwork
and may find it hard to know where to start with a project or homework

Your child may focus on only part of a question and rush answers
leading to underachievement in tests.

This may mean they are placed in a group with a lower ability,
which they may find frustrating and embarrassing and so rush through things
even more.

Isolation in the playground can also make your child more at
risk of being
bullied – or becoming a bully
themself.

Children with symptoms of inattention often don't perform to
their full potential and are therefore more likely to get lower grades, fail
more exams and spend less time at school.

Outcome of ADHD

ADHD is very variable in its presentation and not all children
and young people are severely affected.

Additionally those individuals without major degrees of
hyperactivity or challenging behaviour (eg with the inattentive sub-type of
ADHD) appear to do better in the long term, given appropriate early diagnosis
and support, particularly at school and college.

Children with ADHD can be engaging and spontaneous and amusing,
and good company, although experience shows that over the longer term they come
to be regarded as 'wearing' and distracting and exhausting for others to be
with or tolerate.

Unsurprisingly the combination of difficulties presenting in
children and young people diagnosed with ADHD is often associated with
increased rates of observed social and educational failure,
anxiety and
depression – which is
often accompanied by a marked reduction in self-esteem.

Early use of
cigarettes,
alcohol and illicit
drugs, together with
problems of adolescent adjustment and behaviour are more common, may lead to
inappropriate sexual experimentation, delinquency, offending and involvement
with the criminal justice system.

Fortunately, there's some evidence that early diagnosis and
management may help some of these adverse long-term consequences.

This is the main challenge for professionals and families
setting out to treat, support and care for this group of children and young
people towards adulthood.

ADHD symptoms can persist, to varying degrees of severity and
impairment, in up to 60 per cent of young adults. This is discussed further in
other articles in this series.

The materials in this web site are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. The web site does not have answers to all problems. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor - for further information see our Terms and conditions.